March 4, 2020 - Issue: Vol. 166, No. 43 — Daily Edition116th Congress (2019 - 2020) - 2nd Session
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SOCIAL SECURITY AND MEDICARE THOUGHT EXPERIMENT; Congressional Record Vol. 166, No. 43
(House of Representatives - March 04, 2020)
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[Pages H1496-H1499] From the Congressional Record Online through the Government Publishing Office [www.gpo.gov] SOCIAL SECURITY AND MEDICARE THOUGHT EXPERIMENT The SPEAKER pro tempore. Under the Speaker's announced policy of January 3, 2019, the gentleman from Arizona (Mr. Schweikert) is recognized for 60 minutes as the designee of the minority leader. Mr. SCHWEIKERT. Mr. Speaker, we are going to actually try to touch on 3 or 4 different things this evening, and I am going to try to make it all sort of connect together. On a personal level, I was very pleased as we were doing the supplemental and the mechanism in regard to the coronavirus, a little widget of that was actually the telemedicine piece of legislation that I believe Mr. Thompson from the Ways and Means Committee and myself have offered. It is always nice to see some of these ideas you have been working on getting lifted up and moved forward. But this evening I actually want to sort of continue to talk about science, and the fact of the matter is, the impact it can have if we actually think forward on functionally our debt, our [[Page H1497]] deficits, and our ability to keep our promises. You know, I have been behind this mic dozens and dozens of times with my little boards, trying to demonstrate that over the next 30 years, functioning Social Security and Medicare, these are earned benefits, but they also are the primary drivers of U.S. debt. It is almost all of it. And a lot of it is just demographics, we are getting older as a society, and most of it is actually Medicare, it is healthcare costs. And it turns out that there are opportunities that, if we can embrace technology to actually disrupt some of those healthcare costs--and at the end, we always sort of talk about we need to grow the economy, we need tax policy, we need immigration policy, we need regulatory policy, we need incentives for labor force participation, there are all these things that make the economy grow so we have the resources, the receipts, revenues, tax revenues, and other things, to actually keep our promises. But one of the other things we could do is also disrupt the price of healthcare. So just as a thought experiment, except it is actually based in the living math--this slide is a little hard to deal with--but think of this, over the next 30 years--and this isn't adjusted for inflation-- but over the next 30 years, if you were to remove Social Security and Medicare, you would have $23 trillion in the bank. If you roll Social Security and Medicare back, you are $103 trillion in debt, and it is mostly Medicare, it is mostly healthcare costs. Well, 30 percent of that healthcare cost is just diabetes--and that is what this slide is sort of walking through--diagnosed, the individuals we know about, those we are expecting to come in the future years, and the cost curve. The fact of the matter is, our investments, our ability to build policy that gets us to solutions for diabetes--and diabetes is complicated, you know, there are autoimmune issues, there are lifestyle issues, some are just some genetic issues. It is complicated. {time} 1700 But understand just curing diabetes would be 30 percent of the Medicare costs we are projecting over the next 30 years. It is a demonstration, when we can get the incentives here correct, to push science for these little labs, for these really smart universities that actually will break off something and go set up and raise capital and do these high-risk experiments to produce disruptions, cures, how important that is actually to our society today but also into the future. Because if those little biologic labs can produce a cure, can produce new therapeutics, and change this cost curve, they also change the projection of U.S. economics, U.S. debt. I am trying to build an understanding here. So think about what we just did on the floor. We just moved eight-billion-something dollars working through the coronavirus, making sure there are supplementals and all these other things, and we also have had briefings, even earlier today, of some of the small labs and Big Pharma and little pharma that are desperately working to produce vaccines to also new therapeutics, antivirals. Yet, this same body in December moved a piece of legislation through here that would functionally crush, would functionally put those small biologic innovators out of business. It would destroy what is often called the ``capital stack,'' the ability to raise money for high-risk therapeutics that most of the time fail. If we care about drug prices, which both the Republican side and the Democrat side all focus on, can we make sure that, if you are going to move a bill like they did, H.R. 3, that--functionally you are going to get some price efficiency here, but you are going to wipe out the very innovation and the very biologics and small pharmas that we are relying on right now to produce some of the very disruptions for what is going on in the world right now. Understand, we have to be so careful that we don't satiate our current political desire--and it is a real one, to deal with the cost of pharmaceuticals--and end up destroying future innovation that will save lives, but also make sure we have the infrastructure for when we take on something like we are right now with the virus around the world. It turns out one of our greatest debt drivers is diabetes. It is 30 percent of the cost of Medicare over the next 30 years. So why show this board? Just a couple days ago, I came across a series of articles talking about another example of a miracle that science is bringing us. This is a mouse experiment. And traditionally when you see a mouse experiment, we are still a decade away from the therapeutic. But this should be stunningly hopeful. They functionally found a way to put in living cells that associate as a pancreatic cell--and this just comes from reading three or four articles in some of the science journals-- that produced insulin in this mouse experiment. Is this the beginning of a therapeutic that is either a cure for part of the diabetic population, or a substantial portion of it, that also happens to have the economic benefit of dramatically changing the cost curve of healthcare, dramatically changing the cost curve of Medicare and Medicaid and so many other things? As we sit here and talk about everything from conversations around the coronavirus to debt and deficits, understand if the primary driver of our deficits are functioning healthcare costs--and really it is actually our demographics; we have 74 million of us who are baby boomers, and we are moving into our benefit years--how do we build policy around here that says this is potentially a miracle? If we can make this miracle work for our brothers and sisters across the country, how do we incentivize investment in this type of technology that not only may partially or substantially cure diabetes, but it also solves one of our greatest debt problems in the future? This is actually the sort of thing Republicans and Democrats should be embracing and the policy and ideas to move capital, to move incentives to make this work. If this body is going to even have a discussion saying, hey, the world economics are going to slow down for a little while because of what is going on and we want to do some stimuli; talk about doing stimuli that actually isn't just a momentary change, but actually would change our future debt curve because it provides cures for our brothers and sisters with diabetes, a chronic condition that is 30 percent of just Medicare's future spending. I am asking us to think not only strategically and creatively, but also incentivize the very science that actually helps change our future. And it is here. This is really exciting stuff. You know, you hope and pray that the continuation of the experiments and the science continue to go in this direction, this is a big deal. And it is not only a big deal from a science standpoint for our brothers and sisters with diabetes, but even from debt and deficits. It turns out you really can actually have that holistic circle come together if we can get our policies right around here. So another thing we spend a lot of time on is talking about energy policy. How do you deal with everything from the issues of greenhouse gases and how dysfunctional our actual policies are here? And I don't mean to get snarky, but on one hand people get behind these microphones, and we give these beautiful speeches about how much we care. And then we look the other way when the actual things are going on in our economy are actually making things worse. And let me give my example. Part of the thought experiment is to understand--do you see this multicolored layer? That is nuclear generation that is coming off-line. This is a 2017 slide. If you could see the slide--which it is very colorful--you would notice it is substantially taller than the yellow side. The yellow side is photovoltaic. I am from Arizona. I love solar. It is wonderful. But I also realize nuclear power provides this amazing baseload that is really clean. And we have actually been here and shown that. There is a gentleman with a Nobel Prize that wrote an article a few months ago thinking that in about 10 years they will actually have a way to break down nuclear waste with a type of pulse laser. The physics on that are a little beyond me, but this is sort of the point. So we get our policy wrong on trying to keep our nuclear generation up and [[Page H1498]] running, and then we run around giddy that we have had so much photovoltaic hit the market, but you do realize what the slide is telling you? We actually went backwards, because that differential had to be made up by other types of power generation. We fell backwards because we didn't find ways to keep this nuclear power in production. If we are going to talk about things, I just desperately wish we would get our math right. Another thing, this one is optimistic, and this one actually is touching on a piece of legislation from Ways and Means. It is a bipartisan number of Republicans and Democrats trying to push an all- of-the-above-type of model. For those of us in the desert southwest in the afternoons we produce a lot of photovoltaic power, solar power. And then the Sun goes down and we are still running our air conditioners. We actually have incentives for solar, for wind. Why wouldn't you actually design something that is a little more egalitarian in understanding the technology? And this charge is about batteries. And what is really amazing here is--see if I can bend over and read this line--battery prices have had an 85 percent fall in price per density in the last decade. When you see that curve going down, those little black lines, that is actually the falling price of battery storage. Well, if you are going to have in the tax code an incentive for wind generation and solar generation, why wouldn't you have it, also, for battery storage? Why wouldn't you have it for a type of technology that we haven't even thought of that some freaky smart person is working on in their basement or their garage or in a fancy lab right now that they may be about to bring out? So I am going to encourage Members to think about that as we are working on some of these packages, and it is often referred to as extenders and those issues. Why don't we get this right and incentivize those things that actually are the next disruption? Because for us in the desert southwest, incentivizing that power storage actually creates the mechanisms of photovoltaic and other types of generation and smooths it out so it actually works for us. So, please, for anyone that is listening, let's pay attention to that tax legislation. The other one I want to touch on is another piece of legislation I am sponsoring and working on. A couple years ago, we passed something called Q45. No one knows what Q45 is, but it is actually really important. It was everything in the tax reform data spot. It is the concept of a tax credit for capturing carbon. And then the other part of it for sequestering it or using it in other fashions. Wonderful. We have a piece of legislation to take that and make it permanent because, as we have learned, the capital expenditures for the technology to be on top of a smokestack or even the ambient air capture where it is on top of a building and it is just pulling carbon right out of the air, those sometimes are very large capital expenditures. They need a longer time to amortize out their costs. Well, it also turns out there are disruptions in that technology. This is a clip from an article back, oh, let's say, last October, and anyone that is tracking this just basically grab your phone, go to your search engine, and search ``MIT ambient carbon capture.'' They actually even have a little video to show you how it works. What the researchers say on this technology is overnight they may have just cut the cost in half. Cut the cost in half for functioning, just pulling carbon right out of the air, let alone on top of a smokestack. So it turns out that the technology of carbon capture and then the ability--if we could fix some of what we call that Q45, that tax credit that is already on the books, we are just trying to work out its timing--for sequestering that carbon in concrete or using it for enhanced oil recovery or--a couple researchers have been in our office and talked about--they can take that pure carbon with a little bit of a chemical treatment and turn it back into a clean burning hydrocarbon fuel. The technology is here. How do you ever take a body like this, where you have a lot of smart people, but we have lots of different specialties, and keep up to date with the fact that we live in a time of miracles? And if you are one of the people who truly cares about greenhouse gases, carbon in the atmosphere, then you also have the obligation to keep track of the disruption in technology because I will make you the argument, if the underlying math in the article behind this MIT carbon capture is true, it is a miracle, they may have cut the costs of capturing in half. So another one, and this has just been a project of mine for almost 5 years here. I can walk through the concept, and I actually even have a YouTube video. I think if you search ``Schweikert environmental crowdsourcing,'' I have a 90-second YouTube video trying to explain this concept. We all walk around with these super computers in our pockets. We call them a smartphone. What would happen in your community if you had a couple thousand people in your community that had these new little sensors that have hit the market? They are here, they are now. And you can be driving around, it could be your Uber driver, your Lyft driver, your UPS driver, the person driving the kids to soccer practice and every few minutes it is taking a sample as you go through the neighborhoods. You would actually have crowdsourced environmental data. Because today, what we do is we put up these towers, and those towers cost about a million dollars a year just to maintain, but they lack so much of the community information you actually need. And I will get to my punchline here where this makes sense. How do you know that the business over here is a good camper, but the folks down the street are painting cars in their backyard? Well, the fixed tower never tells you that. If you actually have a crowdsourced model of collecting air quality samples, you know the business is a good actor over here, but you have clowns over here breaking the law. Capture them. It turns out if you built an air quality crowdsourcing model in your community--the world we have today, where you fill out lots of paperwork, then shove it in file cabinets, do the papers and file cabinets actually make the air quality cleaner in your neighborhood? Of course not. It is a 1938 regulatory model. We document things, and then when someone screws up, we know who to sue. {time} 1715 I will make you the argument that if you could crowdsource air quality samples in your neighborhood, you don't need the businesses or the others who are licensed today to fill out paperwork every quarter, every 6 months, every year, because if they screw up, you capture them immediately. Think about it. You could crash the bureaucracy. You could crash filling out paperwork to shove in file cabinets and keep the air quality much, much healthier because you capture when there is a bad actor or when something has gone wrong. And you capture it instantly. That community science, that citizen science, that crowdsourcing is here. It turns out that lots of smart people around the country are now producing products that will let you do this. I am ordering a couple different ones, but this is one version we pulled off the internet just the other day. What they are trying to point to here is that this is how we do it today. We put up a single tower. It costs a million dollars a year. The technology is great. It has great sensitivity, but it doesn't tell you where the bad actor is. In a crowdsource model, you instantly find out where the bad actor is. In my State, in my county, Maricopa County Air Quality, instead of them being collectors of paperwork, they would have the data come in. They could see it on the heat map and immediately know where to go take a look to see if there is something wrong happening. I am trying to make the argument--do you remember what I was saying earlier?--that we have to grow the economy rather vigorously to be able to have the resources to keep our promises. One of the things on that list, besides a tax policy that works and an immigration policy, was a regulatory policy. I have never been thrilled when people walk around and use the term: ``Oh, we are going to deregulate.'' I beg of [[Page H1499]] you to think about ``smart regulations.'' This requires a dramatically smaller bureaucracy, dramatically less burden on those who are creating productive capacity in our communities, yet it would keep us healthier and would show us where the bad actors are. I beg of this body, think forward. We keep designing pieces of legislation around here that might have been brilliant if it was still the 1980s or early 1990s. How do we push the way we think of everything, from the environment to environmental protection all the way down to creating the next generation of pharmaceuticals that cure us? I truly believe we live in a time of miracles. I also believe that our inability to be forward-thinking in this body is one of the biggest problems we have in these sorts of technologies reaching our communities. We always start with this slide, because, one more time: What is the greatest fragility, long term, to this country? I am going to argue it is debt, but that debt is driven by our demographics. Our birth rates have collapsed over the last couple of decades, particularly these last few years. There is a large number of us who are baby boomers; we have our earned benefits coming to us. If you look at the debt accumulation that is about to happen, it is stunning. How do we build a path that makes it so that we can keep our promises and still have a growing economy so that my 4-year-old daughter has the same opportunities I have had? My brothers and sisters on the left will often come up with: ``Well, we will tax rich people.'' My brothers and sisters on the right will often say: ``Well, we are going to find waste and fraud.'' You do realize that is mathematical lunacy? None of that works mathematically. You have to grow the economy. You have to have a disruption in healthcare prices. You have to have a disruption of how you incentivize people to stay in the labor force. That is why we put up this slide, because we believe there are these five pillars that if we get the economic growth; the labor force participation; the adoption of disruptive technology; the population stability of encouraging family formation; and if you are going to change the immigration system, you actually incentivize more of a talent-based immigration system, because you need the economic velocity. Now, a lot of this is really politically uncomfortable. I mean, some of these things, when you go talk about it, people get really mad because they are not comfortable with it. But it is almost the only way, at least in our little office, that we have been able to build a model that we can have enough economic growth, enough tax revenues, enough change in the price of what our promises are that we end up having a pretty amazing future as a country. How do you ever get a body like this, where you have lots of smart people, to act when a lot of what we know is long since out of date and when the math is really, really uncomfortable to deal with and talk about? When you show up in front of an audience at home and say, ``You do understand the biggest driver of debt is Medicare?'' you will get booed, hissed at. But you need to understand, if you don't talk about it, how do you save it? Remember, the Medicare trust fund, which is the part A, has only a few years left, and then it is gone. We need to step up, both Democrats and Republicans, and start telling the truth about the math, maybe invest in that crazy thing called a calculator and start to build a model of how we disrupt the prices, how we grow the economy, how we create the velocity that makes this work and provides hope and opportunity. My thesis is very, very simple: It is here. There is a way to do it. And the biggest barrier to it happening is this body here. We need to change the way we look at the disruption of technology. The last one I will give you is just this simple example. I have come to the floor multiple times and sort of done a thought experiment: the technology of something that looks like a large kazoo that you can blow into and instantly tells you that you have the flu, that instantly can bounce off your medical records on your phone, that knows you are not allergic to a certain antiviral, and that orders your antivirals. Isn't that wonderful? Think about just the cost disruption that technology would have, particularly with what is going on right now. It turns out that technology exists, yet the professor who was working on it had incredible difficulties raising capital, being able to get investors to move it forward. You know why? Because it is functionally illegal. It would save lots of money, but the algorithm for being allowed to write a prescription is functionally illegal. It is illegal under State licensing laws, the Social Security Act, the way we reimburse. We need to become much more forward-thinking because it is the way we save ourselves. If we stay the way we are, we do nothing but bathe in debt and stagnation. But there is a path. Mr. Speaker, I yield back the balance of my time. ____________________
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